Orbital cellulitis causes: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
m (Bot: Removing from Primary care)
 
(41 intermediate revisions by 6 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Orbital cellulitis}}
{{Orbital cellulitis}}
{{CMG}}; {{AE}} {{Ochuko}}
{{CMG}}; {{AE}} {{Ochuko}}; {{TarekNafee}}


==Overview==
==Overview==
Orbital cellulitis occurs commonly from bacterial infection spread by the paranasal sinuses. Other ways in which orbital cellulitis may occur is from infection in the blood stream and from an eyelid skin infection. Upper respiratory infection, sinusitis, trauma to the eye, ocular or periocular infection and systemic infection all increase one’s risk of orbital cellulitis.[[Staphylococcus aureus]], [[Streptococcus pneumoniae]] and beta-hemolytic streptococci are three bacteria that can be responsible for orbital cellulitis.
Orbital cellulitis occurs most commonly from typical [[bacterial infections]]. In some cases, [[Mycobacterium|mycobacteria]] or [[Mycosis|mycosis]] may also be implicated. The most common underlying condition is [[Sinusitis|ethmoid sinusitis]], which has been reported in 90-98% of orbital cellulitis cases. The most commonly reported [[Pathogen|pathogens]] are [[Staphylococcus aureus|''Staphylococcus aureus'']], [[Streptococcus|''Streptococcus spp.'']], and [[Haemophilus influenzae|''Haemophilus influenzae'']]. With the rise of [[Antibiotic resistance|microbial resistance]], [[Methicillin-resistant staphylococcus aureus|methicillian-resistant ''Staphylococcus aureus'' (MRSA)]] must be considered as a potential cause and correlated with geographic [[prevalence]]. Though some causes may be uncommon, orbital cellulitis is a medical emergency and all [[etiologies]] must be considered.<ref name="pmid15318671">{{cite journal| author=Hasanee K, Sharma S| title=Ophthaproblem. Orbital cellulitis. | journal=Can Fam Physician | year= 2004 | volume= 50 | issue=  | pages= 359, 365, 367 | pmid=15318671 | doi= | pmc=2214559 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15318671  }} </ref><ref name="pmid22224014">{{cite journal| author=Lam Choi VB, Yuen HK, Biswas J, Yanoff M| title=Update in pathological diagnosis of orbital infections and inflammations. | journal=Middle East Afr J Ophthalmol | year= 2011 | volume= 18 | issue= 4 | pages= 268-76 | pmid=22224014 | doi=10.4103/0974-9233.90127 | pmc=3249811 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22224014  }} </ref><ref name=merckmanualorbitalcellulitis> Merck Manual Professional Version (2016)https://www.merckmanuals.com/professional/eye-disorders/orbital-diseases/preseptal-and-orbital-cellulitis</ref><ref name=eyewikiorbitalcellulitis> American Academy of Ophthalmology Eyewiki (2015)http://eyewiki.aao.org/Orbital_Cellulitis#Etiology</ref><ref name="pmid16874168">{{cite journal| author=Nageswaran S, Woods CR, Benjamin DK, Givner LB, Shetty AK| title=Orbital cellulitis in children. | journal=Pediatr Infect Dis J | year= 2006 | volume= 25 | issue= 8 | pages= 695-9 | pmid=16874168 | doi=10.1097/01.inf.0000227820.36036.f1 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16874168  }} </ref><ref name="pmid22346113">{{cite journal| author=Chaudhry IA, Al-Rashed W, Arat YO| title=The hot orbit: orbital cellulitis. | journal=Middle East Afr J Ophthalmol | year= 2012 | volume= 19 | issue= 1 | pages= 34-42 | pmid=22346113 | doi=10.4103/0974-9233.92114 | pmc=3277022 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22346113  }} </ref>


==Causes==
==Causes==
===Life Threatening Causes===
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.


===Common Causes===
Orbital cellulitis occurs most commonly from [[bacterial infection]]. In some cases, [[mycobacterial]] or [[fungal]] infections are observed.<ref name="pmid15318671">{{cite journal| author=Hasanee K, Sharma S| title=Ophthaproblem. Orbital cellulitis. | journal=Can Fam Physician | year= 2004 | volume= 50 | issue=  | pages= 359, 365, 367 | pmid=15318671 | doi= | pmc=2214559 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15318671  }} </ref><ref name="pmid22224014">{{cite journal| author=Lam Choi VB, Yuen HK, Biswas J, Yanoff M| title=Update in pathological diagnosis of orbital infections and inflammations. | journal=Middle East Afr J Ophthalmol | year= 2011 | volume= 18 | issue= 4 | pages= 268-76 | pmid=22224014 | doi=10.4103/0974-9233.90127 | pmc=3249811 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22224014  }} </ref><ref name=merckmanualorbitalcellulitis> Merck Manual Professional Version (2016)https://www.merckmanuals.com/professional/eye-disorders/orbital-diseases/preseptal-and-orbital-cellulitis</ref><ref name=eyewikiorbitalcellulitis> American Academy of Ophthalmology Eyewiki (2015)http://eyewiki.aao.org/Orbital_Cellulitis#Etiology</ref> Difficulty arises in identifying a specific [[organism]] due to challenges in culturing the [[Orbit (anatomy)|retroseptal orbital region]].<ref name="pmid21232022">{{cite journal| author=Baring DE, Hilmi OJ| title=An evidence based review of periorbital cellulitis. | journal=Clin Otolaryngol | year= 2011 | volume= 36 | issue= 1 | pages= 57-64 | pmid=21232022 | doi=10.1111/j.1749-4486.2011.02258.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21232022  }} </ref>
*[[sinusitis|Bacterial rhinosinusitis]]
 
*[[Haemophilus influenzae]]
===Cause by Pathogen===
*[[Staphylococcus aureus]]
Common [[bacterial]] causes of orbital cellulitis include:<ref name="pmid15318671">{{cite journal| author=Hasanee K, Sharma S| title=Ophthaproblem. Orbital cellulitis. | journal=Can Fam Physician | year= 2004 | volume= 50 | issue=  | pages= 359, 365, 367 | pmid=15318671 | doi= | pmc=2214559 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15318671  }} </ref><ref name="pmid22224014">{{cite journal| author=Lam Choi VB, Yuen HK, Biswas J, Yanoff M| title=Update in pathological diagnosis of orbital infections and inflammations. | journal=Middle East Afr J Ophthalmol | year= 2011 | volume= 18 | issue= 4 | pages= 268-76 | pmid=22224014 | doi=10.4103/0974-9233.90127 | pmc=3249811 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22224014  }} </ref><ref name=merckmanualorbitalcellulitis> Merck Manual Professional Version (2016)https://www.merckmanuals.com/professional/eye-disorders/orbital-diseases/preseptal-and-orbital-cellulitis</ref>
*[[Streptococci]]
*''[[Staphylococcus aureus]]''
*[[Streptococcus anginosus]]
*''[[Streptococcus|Streptococcus spp.]]''
*''[[Haemophilus influenzae]]''
** With the dissemination of [[Haemophilus influenzae Type b (Hib) Vaccine (patient information)|Haemophilus influenza type b (Hib) vaccine]], the [[incidence]] of [[Haemophilus influenzae|''Haemophilus influenzae'']]-caused orbital cellulitis has decreased significantly.
*[[Methicillin-resistant staphylococcus aureus|Methicillin-resistant ''Staphylococcus aureus'' (MRSA)]]
**Rise in [[Antibiotic resistance|microbial resistance]], [[Methicillin-resistant staphylococcus aureus|MRSA]] must be considered as a potential cause and correlated with geographic [[prevalence]].
*[[Aerobic organism|Aerobic]] and [[Anaerobic organism|anaerobic bacteria]]


===Causes by Organ System===
In [[Immunodeficiency|immunocompromised]] patients, additional causes may include:<ref name="pmid22224014">{{cite journal| author=Lam Choi VB, Yuen HK, Biswas J, Yanoff M| title=Update in pathological diagnosis of orbital infections and inflammations. | journal=Middle East Afr J Ophthalmol | year= 2011 | volume= 18 | issue= 4 | pages= 268-76 | pmid=22224014 | doi=10.4103/0974-9233.90127 | pmc=3249811 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22224014  }} </ref>
*[[Mycosis|Fungal]] infection
**[[Zygomycosis|Mucormycosis]]
**[[Aspergillosis|Aspergilliosis]]
*[[Mycobacterium|Mycobacterial]] infection
**''[[Mycobacterium tuberculosis]]''


===Cause by Etiology===
Based on [[etiology]], the most common underlying condition causing orbital cellulitis is [[Sinusitis|ethmoid sinusitis]], which occurs in 90-98% of cases.<ref name="pmid15318671">{{cite journal| author=Hasanee K, Sharma S| title=Ophthaproblem. Orbital cellulitis. | journal=Can Fam Physician | year= 2004 | volume= 50 | issue=  | pages= 359, 365, 367 | pmid=15318671 | doi= | pmc=2214559 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15318671  }} </ref><ref name="pmid16874168">{{cite journal| author=Nageswaran S, Woods CR, Benjamin DK, Givner LB, Shetty AK| title=Orbital cellulitis in children. | journal=Pediatr Infect Dis J | year= 2006 | volume= 25 | issue= 8 | pages= 695-9 | pmid=16874168 | doi=10.1097/01.inf.0000227820.36036.f1 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16874168  }} </ref><ref name="pmid22346113">{{cite journal| author=Chaudhry IA, Al-Rashed W, Arat YO| title=The hot orbit: orbital cellulitis. | journal=Middle East Afr J Ophthalmol | year= 2012 | volume= 19 | issue= 1 | pages= 34-42 | pmid=22346113 | doi=10.4103/0974-9233.92114 | pmc=3277022 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22346113  }} </ref> Additional causes based on etiology include:<ref name="pmid22224014">{{cite journal| author=Lam Choi VB, Yuen HK, Biswas J, Yanoff M| title=Update in pathological diagnosis of orbital infections and inflammations. | journal=Middle East Afr J Ophthalmol | year= 2011 | volume= 18 | issue= 4 | pages= 268-76 | pmid=22224014 | doi=10.4103/0974-9233.90127 | pmc=3249811 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22224014  }} </ref><ref name="pmid21232022">{{cite journal| author=Baring DE, Hilmi OJ| title=An evidence based review of periorbital cellulitis. | journal=Clin Otolaryngol | year= 2011 | volume= 36 | issue= 1 | pages= 57-64 | pmid=21232022 | doi=10.1111/j.1749-4486.2011.02258.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21232022  }} </ref>
*'''[[Sinusitis]]''':
**[[Staphylococcus aureus|''Staphylococcus aureus'']]
**[[Streptococcus|''Streptococcus spp.'']]
**[[Haemophilus influenzae|''Haemophilus influenzae'']]
*'''[[Dacryocystitis]], [[dacryoadenitis]], and other [[lacrimal duct]] abnormalities'''
**[[Staphylococcus aureus|''Staphylococcus aureus'']]
**[[Streptococcus pneumoniae|''Streptococcus pneumoniae'']]
**[[Streptococcus pyogenes|''Streptococcus pyogenes'']]
**[[Haemophilus influenzae|''Haemophilus influenzae'']]
*'''Traumatic/[[Foreign body|Foreign body]]''':
**[[Staphylococcus aureus|''Staphylococcus aureus'']]
**[[Staphylococcus epidermidis|''Staphylococcus epidermidis'']]
**[[Enterococcus|Enterococcus spp.]]
**[[Escherichia coli|''Escherichia coli'']]
**[[Eikenella|''Eikenella spp.'']]
*'''Spread from superficial [[infections]] of the face or adjacent [[soft tissue]]''':
**[[Staphylococcus aureus|''Staphylococcus aureus'']]
**[[Streptococcus pyogenes|''Streptococcus pyogenes'']]
*'''[[Dental caries|Dental caries]]/[[Tooth abscess|Tooth abscess]]''':
**[[Bacteroides|''Bacteroides spp.'']]
**[[Anaerobic organism|anaerobes]]
**[[Gram-negative bacteria|gram negative]] rods
*'''Iatrogenic/post-surgical procedures''':
**[[Staphylococcus aureus|''Staphylococcus aureus'']]
**[[Streptococcus|''Streptococcus spp.'']]
*'''[[Immunocompromised]] patient''':
**[[Zygomycosis|''Mucormycosis'']]
**''[[Aspergillosis|Aspergilliosis]]''
**''[[Mycobacterium tuberculosis]]''
*'''[[Diabetic]] patients with or without history of [[diabetic ketoacidosis]]'''
**[[Pseudomonas aeruginosa|''Pseudomonas aeruginosa'']]
**[[Klebsiella pneumoniae|''Klebsiella pneumoniae'']]


===Cause by Organ System===
{|style="width:80%; height:100px" border="1"
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
Line 93: Line 136:
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
| '''Ophthalmologic'''
|bgcolor="Beige"| [[Blepharoplasty]], [[dacryocystitis]], [[dacryocystorhinostomy]], [[blepharoplasty|eyelid surgery]], [[eye surgery|ophthalmic surgery]], [[orbital decompression]], [[blowout fracture|orbital fracture]], [[osteomyelitis|osteomyelitis of the orbital bones]], [[radial keratotomy]], [[eye surgery|retinal surgery]], [[strabismus surgery]]
|bgcolor="Beige"| [[Blepharoplasty]], [[dacryocystitis]], [[dacryocystorhinostomy]], [[blepharoplasty|eyelid surgery]], [[eye surgery|ophthalmic surgery]], orbital decompression, [[blowout fracture|orbital fracture]], [[osteomyelitis|osteomyelitis of the orbital bones]], [[radial keratotomy]], [[eye surgery|retinal surgery]], [[strabismus surgery]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
Line 135: Line 178:


===Causes in Alphabetical Order===
===Causes in Alphabetical Order===
{{columns-list|3|
{{columns-list|
*[[Aeromonas hydrophila]]  
*[[Aeromonas hydrophila]]  
*[[Anaerobes]]
*[[Anaerobes]]
Line 194: Line 237:
{{Reflist|2}}
{{Reflist|2}}


{{WH}}
{{WS}}
[[Category:Emergency mdicine]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
[[Category:Bacterial diseases]]
[[Category:Ophthalmology]]
[[Category:Ophthalmology]]
[[Category:Crowdiagnosis]]
{{WH}}
{{WS}}

Latest revision as of 23:26, 29 July 2020

Orbital cellulitis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Orbital cellulitis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Orbital cellulitis causes On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Orbital cellulitis causes

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Orbital cellulitis causes

CDC on Orbital cellulitis causes

Orbital cellulitis causes in the news

Blogs on Orbital cellulitis causes

Directions to Hospitals Treating Orbital cellulitis

Risk calculators and risk factors for Orbital cellulitis causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]; Tarek Nafee, M.D. [3]

Overview

Orbital cellulitis occurs most commonly from typical bacterial infections. In some cases, mycobacteria or mycosis may also be implicated. The most common underlying condition is ethmoid sinusitis, which has been reported in 90-98% of orbital cellulitis cases. The most commonly reported pathogens are Staphylococcus aureus, Streptococcus spp., and Haemophilus influenzae. With the rise of microbial resistance, methicillian-resistant Staphylococcus aureus (MRSA) must be considered as a potential cause and correlated with geographic prevalence. Though some causes may be uncommon, orbital cellulitis is a medical emergency and all etiologies must be considered.[1][2][3][4][5][6]

Causes

Orbital cellulitis occurs most commonly from bacterial infection. In some cases, mycobacterial or fungal infections are observed.[1][2][3][4] Difficulty arises in identifying a specific organism due to challenges in culturing the retroseptal orbital region.[7]

Cause by Pathogen

Common bacterial causes of orbital cellulitis include:[1][2][3]

In immunocompromised patients, additional causes may include:[2]

Cause by Etiology

Based on etiology, the most common underlying condition causing orbital cellulitis is ethmoid sinusitis, which occurs in 90-98% of cases.[1][5][6] Additional causes based on etiology include:[2][7]

Cause by Organ System

Cardiovascular No underlying causes
Chemical/Poisoning No underlying causes
Dental Dental infection, tooth abscess
Dermatologic No underlying causes
Drug Side Effect No underlying causes
Ear Nose Throat Ethmoid sinusitis, otitis media, sinusitis
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic Peribulbar anesthesia, surgical trauma
Infectious Disease Aeromonas hydrophila, anaerobes, arcanobacterium, aspergillosis, aspergillus, bacterial rhinosinusitis, bacteroides, beta-hemolytic streptococci, dacryocystitis, dental infection, eikenella corrodens, enterococcus, ethmoid sinusitis, haemophilus influenzae, haemophilus parainfluenzae, infected mucocele, klebsiella pneumoniae, moraxella catarrhalis, MRSA, MSSA, mucor, mucorales, mucormycosis, mycobacterium tuberculosis, neisseria gonorrhea, osteomyelitis of the orbital bones, otitis media, peptostreptococcus, pseudomonas aeruginosa, rothia mucilaginosa, sinusitis, staphylococcus aureus, streptococcus anginosus, streptococcus milleri, streptococcus pneumoniae, streptococcus pyogenes, streptococcus, tooth abscess, varicella
Musculoskeletal/Orthopedic No underlying causes
Neurologic No underlying causes
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Ophthalmologic Blepharoplasty, dacryocystitis, dacryocystorhinostomy, eyelid surgery, ophthalmic surgery, orbital decompression, orbital fracture, osteomyelitis of the orbital bones, radial keratotomy, retinal surgery, strabismus surgery
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary Mycobacterium tuberculosis
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy No underlying causes
Sexual No underlying causes
Trauma Orbital fracture, trauma
Urologic No underlying causes
Miscellaneous Foreign body, phlebitis of the facial veins


Causes in Alphabetical Order

References

  1. ↑ 1.0 1.1 1.2 1.3 Hasanee K, Sharma S (2004). "Ophthaproblem. Orbital cellulitis". Can Fam Physician. 50: 359, 365, 367. PMC 2214559. PMID 15318671.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 Lam Choi VB, Yuen HK, Biswas J, Yanoff M (2011). "Update in pathological diagnosis of orbital infections and inflammations". Middle East Afr J Ophthalmol. 18 (4): 268–76. doi:10.4103/0974-9233.90127. PMC 3249811. PMID 22224014.
  3. ↑ 3.0 3.1 3.2 Merck Manual Professional Version (2016)https://www.merckmanuals.com/professional/eye-disorders/orbital-diseases/preseptal-and-orbital-cellulitis
  4. ↑ 4.0 4.1 American Academy of Ophthalmology Eyewiki (2015)http://eyewiki.aao.org/Orbital_Cellulitis#Etiology
  5. ↑ 5.0 5.1 Nageswaran S, Woods CR, Benjamin DK, Givner LB, Shetty AK (2006). "Orbital cellulitis in children". Pediatr Infect Dis J. 25 (8): 695–9. doi:10.1097/01.inf.0000227820.36036.f1. PMID 16874168.
  6. ↑ 6.0 6.1 Chaudhry IA, Al-Rashed W, Arat YO (2012). "The hot orbit: orbital cellulitis". Middle East Afr J Ophthalmol. 19 (1): 34–42. doi:10.4103/0974-9233.92114. PMC 3277022. PMID 22346113.
  7. ↑ 7.0 7.1 Baring DE, Hilmi OJ (2011). "An evidence based review of periorbital cellulitis". Clin Otolaryngol. 36 (1): 57–64. doi:10.1111/j.1749-4486.2011.02258.x. PMID 21232022.


Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Orbital_cellulitis_causes&oldid=1641422"